A Model for Human Factors Design of a Trauma OR at the Foothills Medical Centre

Transcription

1 A Model for Human Factors Design of a Trauma OR at the Foothills Medical Centre Jonas Shultz, MSc EDAC Human Factors Specialist, HQCA Adjunct Lecturer, Anesthesia, UofC Jonas.Shultz@hqca.ca Christine Vis, BSN RN Manager, Trauma Services and PCU 44 Trauma/Surgery, AHS Chris.Vis@AHS.ca OCT 27, 2016

2 Presentation Overview Simulation-based mock-up evaluation framework Interventional Trauma Operating Room ITOR evaluations Next Steps

3 Framework Simulation-based mock-up evaluation framework - Started in Feb Printed in Mar Document and appendices available from: hqca.ca/humanfactors

4 Introduction Health Quality Council of Alberta An independent corporation legislated under the Health Quality Council of Alberta Act with a mandate to promote and improve patient safety and health service quality on a province-wide basis.

5 Introduction Project lead / principle author Jonas Shultz Project team / contributing authors Bev Knudtson Jason Laberge Mirette Dubé Steve Fowler Susan Biesbroek Trevor Peter

6 Stakeholders Contributed knowledge, expertise and feedback to develop and disseminate the framework

7 Stakeholders CSA Z8000 Canadian Health Care Facilities Provides a nationally recognized baseline for the design and construction of hospitals and selected care facilities.

8 Guidelines in Alberta Health Facilities Capital Program Manual Describes responsibilities, accountabilities and processes for the planning and delivery of the Program for Alberta.

9 Simulation-based mock-up evaluation

10 Simulation-based mock-up evaluation Full scale mock-up Simple mock-up Detailed mock-up Live mock-up

11 Simulation-based mock-up evaluation Photo used with permission

12 Simulation-based mock-up evaluation Data is collected and analyzed Recommendations made to: Guide design decisions Optimize the environment

13 Taylor, Hignett, Joseph, 2014

14 Simulation-based mock-up evaluation Framework goals: Enhance awareness Assist with planning for an evaluation Provide guidance to conduct evaluation

15

16 RIPCHD.OR Realizing Improved Patient Care through Human-Centered Design in the Operating Room $4M, 4 year AHRQ grant Design safer, more ergonomic OR Multiple simulation-based mock-up evaluations Joseph, Wingler, Allison, 2016 (available from

17 Guiding Principles

18 Pre-design Design Construction / Commissioning Needs assessment Risk assessment Business case Project mgmt plan Functional program Project schedule Include consideration or requirement to conduct a simulation-based mock-up evaluation

19 Pre-design Design Construction / Commissioning Schematic design Design development Construction documents Bidding and negotiation Conduct simulation-based mock-up evaluation

20 Scope Outlined during predesign Should outline Evaluation objectives When to evaluate Costs Time requirements

21 Evaluation objectives

22 When to evaluate

23 Time required

24

25 Selecting task to develop scenarios Task analysis Functional program Design requirements User focus groups Design team questions / concerns Safety reporting data

26 Enacting scenarios Pre-briefing Evaluation objectives Scenario overview Think-aloud protocol Scenario enactment Typically 2-5 scenarios

27 User feedback Debriefing x 2 (participants & observers) Surveys Video analysis Video coding Link analysis Bump analysis

28 Video coding

29 Link analysis Highlights: Motion patterns High traffic areas Interactions between staff and equipment Inefficiencies in staff workflow Space usage Biesbroek, Shultz, Kirkpatrick, Kortbeek, 2012

30 Bump analysis Biesbroek, Shultz, Kirkpatrick, Kortbeek, 2012

31 Disseminating findings Presenting findings Presentation to participants / stakeholders Technical report to design team Consider broad distribution

32 1 What is ITOR? Interventional Trauma Operating Room An operating theatre specifically designed to control bleeding of patients with severe trauma by combining a traditional operating room and an angiography suite with diagnostic imaging capabilities

33 Why? During an average year in Alberta: 1,931 Albertans die from an injury = 5 deaths each day 28,809 Albertans are hospitalized = 79 hospital admissions each day 429,741 Albertans visit emergency departments = 1,177 Emergency Department visits each day Uncontrolled bleeding remains a major factor in early mortality after trauma, contributing to 30 to 40% of traumarelated deaths.

34 Trauma in Calgary

35 Some History Remember the uncontrolled bleeding. Medical advancement: From surgery to angiography embolization

36 Who needs the ITOR?

37 Mock Up Evaluation 2010 Photo used with permission

38 Photo courtesy of DIALOG

39 Photo courtesy of DIALOG

40 Commissioning 2013

41 ITOR Evaluation

42 ITOR: Design modifications 56 recommendations Before / after comparisons to evaluate implemented design changes Kirkpatrick, Vis, Dubé, Biesbroek, Ball, Laberge, Shultz, Rea, Sadler, Holcomb, Kortbeek, 2014

43 ITOR: Design modifications Biesbroek, Shultz, Kirkpatrick, Kortbeek, 2012

44 ITOR: Design modifications Mock-up design (Feb Mock-up 16, 2010) design Built design (Nov 28 & 29, 2012) Biesbroek, Shultz, Kirkpatrick, Kortbeek, 2012

45 ITOR: Design modifications Mock-up design (Feb 16, 2010) Built design (Nov 28 & 29, 2012) Biesbroek, Shultz, Kirkpatrick, Kortbeek, 2012

46 ITOR: Design modifications Nursing area bumps: 44% (25 vs 14) Mock-up design Mock-up (Feb 16, design 2010) Built design Current (Nov 28 design & 29, 2012) Biesbroek, Shultz, Kirkpatrick, Kortbeek, 2012

47 ITOR: Design modifications Mock-up design (Feb 16, 2010) Non bold circle, Bold colour change arrow

48 ITOR: Design modifications Improved space utilization Scenario: Retro-peritoneal bleed and cardiac arrest Mock-up design (Feb 16, 2010) Built design (Nov 28 & 29, 2012)

49 Next Steps

50 Framework ROI Project Medication Room South Health Campus Simple mock-up Detailed mock-up Virtual reality mock-up

51 Framework ROI Project Project Goals Develop evidence-based guidelines outlining which mock-up fidelity is most effective cost effectiveness (ROI) outcomes (identified latent conditions, hazards, etc)

52 Questions?